A new study says Africa suffers from a co-epidemic of HIV/AIDS and food insecurity. Researchers say treatment and better nutrition go hand-in-hand in controlling the epidemic.

Dr. Sheri Weiser said when people fall ill due to HIV, accessing food becomes “progressively more difficult.”

“Food insecurity and HIV are interacting like a vicious cycle to worsen the severity as well as enhancing vulnerability to the other condition,” she said.

Weiser is an assistant professor of medicine at the HIV/AIDS Division at San Francisco General Hospital and Trauma Center. She’s also the study’s principal investigator.

“We started having data from Botswana and Swaziland showing that food insecurity was increasing risky sexual practices. So you saw women who were exchanging sex in order to get food to feed their children or having difficulty insisting on condom use when they were dependent on their partner for food. And that food insecurity was also worsening vulnerability to sexual violence. And all of these were contributing to driving HIV,” she said.

A person infected by HIV is further weakened by poor nutrition. That’s an additional blow to the immune system.

“We saw that food insecurity was driving increases in opportunistic infections, worse response to treatment, making it really difficult for people to take their medications and adhere to their medications and even leading to increased mortality. And interestingly, we saw this not only in sub-Saharan Africa but also in San Francisco and elsewhere in North America,” said Weiser.

The cycle continues when people get sicker and they are unable to find a job to buy food. And stigma from HIV can make it more difficult to find support from others.

Weiser said that at the beginning of the study, 80 percent of those infected with HIV had some level of food insecurity. That began to change when they were given antiretroviral therapy or ART.

“After time on ART and after we followed participants for approximately two years we saw very steep declines in food insecurity. And at the same time we saw parallel increases in their nutritional status and their quality of life and physical health status. So what this really shows is that ART does contribute to a decline in food insecurity,” she said.

Dr. David Bangsberg, director of the Center for Global Health at Massachusetts General Hospital, is the senior author of the study.

He said, “The expansion of HIV treatment in Africa has made great progress in making people healthier and stronger, such that they can return to work and grow food or security meaningful economic employment to purchase food for themselves and their family. So HIV treatment helps improve access to food in a very significant way.”

But Bangsberg added that getting people on antiretroviral therapy does not mean they will stay on it. One reason, he says, is a possible side effect of the drugs.

“As they get better and their bodies begin to recover their appetite returns and experience severe hunger pains in their first few weeks of HIV treatment. Some patients attribute these hunger pains to a side effect to treatment and then some of those will then stop treatment in order to mitigate the hunger pains. Clearly the best response is not to stop treatment, but rather to help someone have access to food.”

Both Bangsberg and Weiser are sharing their findings with U.N. humanitarian agencies and officials from PEPFAR, the President’s Emergency Plan for AIDS Relief.

They warn though that the dual issue of HIV and food insecurity is not just an African problem. They say the same conditions exist among the urban poor in North America, including such cities as San Francisco, Atlanta, Boston and Vancouver. They say as many as 50 percent of HIV infected people in those areas, who are on treatment, are food insecure. 

The study’s findings can be found in the Journal of Acquired Immune Deficiency Syndromes.